Fetal programming of COVID-19: may the barker hypothesis explain the susceptibility of a subset of young adults to develop severe disease?

C. Gerosa, G. Faa, D. Fanni, M. Manchia, J.S. Suri, A. Ravarino, D. Barcellona, G. Pichiri, P. Coni, T. Congiu, M. Piras, G. Cerrone, F. Cau, F. Ledda, V. Aimola, F. Coghe, M. Porcu, R. Cau, G. Orru’, P. Van Eyken, G. La Nasa, M. Castagnola, F. Marongiu, L. Saba

Division of Pathology, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy. clarge@tiscali.it

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• Infectious Diseases
• Public Health

The risk stratification of young adults between subjects who will develop a mild form COVID-19 and subjects who will undergo a severe disease remains inaccurate. In this review, we propose that the Barker hypothesis might explain the increased susceptibility to severe forms of COVID-19 in subjects who underwent intrauterine growth restriction (IUGR). In this paper evidence indicating an association between a low birth weight and an adult phenotype which might favor a severe outcome of SARS-CoV-2 infection are presented: lower lung functional capacity; increased respiratory morbidity; changes in fibrinogen and Factor VII serum levels and dysregulation of the hemostasis and thrombosis system; acquisition of a pro-thrombotic phenotype; low nephron number, with decreased ability to sustain renal function and increased renal morbidity; heart remodeling, with a less efficient cardiac function; endothelial dysfunction, a risk factor for the insurgence of the multiple organ failure; remodeling of arteries, with changes in the elastic properties of the arterial wall, predisposing to the insurgence and progression of atherosclerosis; dysfunction of the innate immune system, a risk factor for immune diseases in adulthood. These data suggest that young and adult subjects born too small (IUGR) or too early (pre-terms) might represent a subgroup of “at risk subjects”, more susceptible toward severe forms of COVID-19. Given that LBW may be considered a surrogate of IUGR, this phenotypic marker should be included among the indispensable clinical data collected in every patient presenting with SARS-COV-2 infection, irrespectively of his/her age.

 

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